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163 West Knoll Brook Drive Lot 31Account #: Billed To: Reference Name: Proposed Facility DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 989900204 Tax PIN/EH #: 5749-43-1722.31 J. D. Crews Homebuilder Subdivision Info: Meadow Ridge Lot # 31 Location/Address: West Knoll Brooke Dr. -27028 Residence Property Size: see map ATC Number: 3968 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATE U IDF OD OF FIVE YEARS. Environmental Health Specialist's Signature: e: lbcb�— CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit Mo has been installed in compliance with Article I 1 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Z� Disposal Systems," but shall in NO WAY be taken as a guartee that the system will function satisfactorily for any given period of time. ece'" T- " r'1 i4�tc i�tE L-5 Septic System Environmental Health Specialist's DCI -ID 05/99 (Revised) r .1aO L� 410 5TD DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 989900204 Billed To: J. D. Crews Homebuilder Reference Name: Proposed Facility Residence Tax PIN/EH #: 5749-43-1722.31 Subdivision Info: Meadow Ridge Lot # 31 Location/Address: West Knoll Brooke Dr. -27028 Property Size: see map ATC Number: 3968 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type Ham- #People #Bedrooms 'I .#Baths 3•S - Dishwasher: 9 Garbage Disposal: ff Washing Machine: d Basement w/Plumbing: lr Basement/No Plumbing: ❑ Commercial Specification: Facility Typenn#People #People/Shift #Seats Industrial Waste: ❑ Lot Size Z+Ae2s Type Water Supply 6OW' W Design Wastewater Flow (GPD) y$D Site: New 12/ Repair ❑ System Specifications: Tank Size /000GAL. Pump Tank GAL. Trench Width a; Rock Depth 1;7- Linear RICO Other: Required Site Modifications/Conditions: 60 IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this stem between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p Ln. on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Sign�ture: DCHD 05/99 (Revised) 9& 3g' c-- Date: ? 1 AW APPLICATION FOR SITE EVALUATION/IMPROVEMENT PRCly E D U E Davie County Health Department Envi onmwtal Heaitb Section P.O. 6 2005 P.O. Box 848/210 Hospital Street JAN Mocksville, NC 27028 (336)751-8760 EALT EWRONMENTAL HH AVIE COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLES REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed tom, D CP—L---W W 5 } jm�812� D+=�S� contact Person �%t�2(2y ` Mailing Address Ito I LZMO{L'57 f _ Home Phone City/State/ZIP ffipCKS YI-I LE- lyG Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation WI/�mprovement Permit/ATC ❑ Both 4. system to Service: "House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People _ �� P #Bedrooms #Bathrooms 3. S PY Dishwasher 4Y Garbage Disposal "asking Machine VBasement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats -- Estimated Water Usage (gallons per day) // 7. Type of water supply: P County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions'of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? ***IMPORTANT*** CLIFNTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT qr SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. 1 � � Property Dimensions: X 1:3.9,x ySb' )c q40 WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # S7# -e/ q3/ 7z-2— llw!j (S8X115 i� — R! 6HT o�f s/, tl f_ Property Address: Road Name iAfd KtJoL.t. BP-onK DY2_ I6(r Dd WEST KhbLi, B2ool<, DTZ, City/Zip i` oc-k5-Ji t(6 4K,2-7oZ? kyT 04 I-C-1 If in a Subdivision provide information, as follows: Name: mw�moo R�DC�C Section: Block: Lot: '31 Date Property Flagged: ( — 7 O'S This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site pians or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred frons this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitab' DATE �— %� O5� SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). -9 L tai Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Invoice No. 11 t � + 310;7. 20.0' Oramage Easement ' f � jr 36 ; ' to 1.374 Acres (dmd) � cd i If ^h• , o a� 1.579 Acres (dmd) as0 Og ti i i /oF tb d t G' 34 30 Acres (dmd) c g GJ � G`R �� t22•`-%� �� J as io .`� 1 _c_5_ ; ` �, 1 3.057 Acres md) 10 V 33 N i i w, , tr® Jr. F, ` 2.548 Acres (dmd) M 32 2.579 Acres (dmd) in 39 lot a, \ t 0 + + 1 \ i IVN 10' Access Easement %% To Conar+or, Area U J-6er — Vehicles ACIIE /YID 61IlAOtiCS AW a t o N9 w PC IAD YR fZUAGI°lAAY N 8547'1ri E _ WEST KNOLL BROOK DR/VE 50' PubGt R',2ht Of WaY r PS 7 Pages 129-131 CONTROL CORNER { t) Front Yard Setbacks are 40' Typical ( 2) S,de Yard Setbacks are 15' Typical ( 3) Rear Yard Setbacks are 34' Typical ( 4) The Current Zoning of The Property is OSR ( 5) AN Utilities Aro to be Underground ( 6) All Lots Will Be Served With Public Water And Private Septic Systems. JACK G. CORRIHER, JR. MEADOW RIDGE PLAT BOOK 7 PAGE 162 A \ b Y \ M \ A . APPUCATION FOR SITE EVAUJATION/IMPROVEMEM' PERMIT & ATCQ�F t� U—E Davie County Health Department Enwrironmenial Heath Sec ioa P.O. Box 846/210 Hospital Stree M AY - 9 2001 =i �� ' / Mocksville, NC 27028 o (336) 751-87606 i �a l�•' � {° ' ENVIRONh1ENTAL NFALiH �A •" '� MAECOUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATIQN IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Ke 1.1 AE -r" L, Foy-m1z Contact Person Ke fJ t=osTt� Hailing Address V& Map tr. TQF-c LPA3c Home Phone i0 4 -'.�4(p -Z7 8 9 City/state/ZIP mJS� ILET�_'ZTo2 8usiaeaa Phone 3o—i23 _rg�0 _ 2. Name on Permit/ATC if Different than Above Hailing Address city/$tate/Zip _. 3. Application For: i(Site Evaluation ❑ Improvement Permit/ATC v Both 4. System to service: iI House ❑ Mobile Home ❑. Business ❑ Industry ❑ Oth,?z S. if Residence: 4 People Bedrooms he ti Bathroor 4- H Dishwasher H Garbage Disposal @MWashing Machine ansement/P2umbing 1:1 Saaemsnf;j'Ho Plumbing 6. If Business/Industry/Other: Specify type f People # 'irk9 Commodes I Showers # Urinals # Water COO]eS'E IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: er County/City ❑ Well (c'Tr; anit.V s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ yes ❑ 11 If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQ[ %:;TED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION, Property Dimensions: 43o X G 53 K 13$ K 458 5749 33 23313 Tax Office PIN: 4 Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: Name: 1A6Aoow Rtoc e ( PRoaoseb) Section: Two Block: Lot: 31 WRITE DIRECTIONS (from Mocksville) to PROPERTY- -LIS 158t�bRrlk • RtGt4T oQ SArIJ i?OkO , RiG4r AX 9N7-RAA/CF ',-o MEADOW /�'rnc,E� /VV �trAD E�_`1) URS 1ZIC,4T _GV Th ErjO GF .STR,c T Date Property Flagged: 'nA Y This is to certify that the information provided is correct to the best of my knowledge. I understand that any p-., mit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the info -:i.ation submitted in this application is falsified or changed. ],also, understand that I am responsible for all charges incrrred from me this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to cater upon above described property located in Davie County and owned by Rap>apm G. 11c.C4AMP,0us- to conduct all testing procedures as necessary to determine the site suitability. DATE m n Y 71 21,b/SIGNATURE _ THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existinl�, ant' , i opr;%ed property lines and dimensions, structures, setbacks, and septic locations). Revised DCEID (07/99) Site Revisit CI4..,.d! a Datc(s): _ Client Notification Date: EBS: . �iYti� rr Account No. Invoice No. • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900654 Billed To: Kenneth Foster Reference Name: Proposed Facility: Residence Property Size PROPERTY INFORMATION Tax PIN/EH #: 5749-33-2338.31 Subdivision Info: Meadowridge Section two Lot # 31 Location/Address: see map Date Evaluated: Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RA REMARKS: LEGEND Landscape Position EVALUATION BY: OTHER(S) PRESENT: R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope CC - Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section Soil/Site Evaluation APPLICANT'S NAME T1 744 PROPOSED FACILITY SUBDIVISION Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit f SECTION_,.j_ LOTZ/ DATE EVALUATED PROPERTY SIZE ROAD NAME Public -e _�-' Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % {o D HORIZON I DEPTH Texture group12" Consistence Structure Mineralogy HORIZON II DEPTH r " Texture group Consistence i Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE c SITE CLASSIFICATION: ✓� LONG-TERM ACCEPTANCE RATE: wc)// REMARKS: 5'?D'%iy �r DCHD (01-90) EVALUATION BY: Zmil/ OTHER(S) PRESENT: ` LEGEND Landscape Position R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope CC - Concave slope CV - Convex slope . T - Terrace FP - Flood plain H.- Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS (provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2